Predictors of positive retroperitoneal lymph nodes in patients with high risk testicular cancer

Stephen Williams, R. Kacker, D. Winston, E. Bahnson, G. S. Steele, J. P. Richie

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease. Materials and Methods: Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30% embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained. Results: Of 353 patients 90 (25%) had greater than 30% embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50%) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46%) and 15 (60%) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95% CI 1.001.04) and lymphovascular invasion (OR 3.52, 95% CI 1.438.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100% embryonal carcinoma was 65.5%, although the negative predictive value for 30% embryonal carcinoma was 85.7%. Conclusions: Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options.

Original languageEnglish (US)
Pages (from-to)2245-2248
Number of pages4
JournalJournal of Urology
Volume186
Issue number6
DOIs
StatePublished - Dec 2011
Externally publishedYes

Fingerprint

Embryonal Carcinoma
Testicular Neoplasms
Lymph Node Excision
Lymph Nodes
Orchiectomy
Counseling
Multivariate Analysis

Keywords

  • carcinoma
  • embryonal
  • lymph node excision
  • testicular neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Predictors of positive retroperitoneal lymph nodes in patients with high risk testicular cancer. / Williams, Stephen; Kacker, R.; Winston, D.; Bahnson, E.; Steele, G. S.; Richie, J. P.

In: Journal of Urology, Vol. 186, No. 6, 12.2011, p. 2245-2248.

Research output: Contribution to journalArticle

Williams, Stephen ; Kacker, R. ; Winston, D. ; Bahnson, E. ; Steele, G. S. ; Richie, J. P. / Predictors of positive retroperitoneal lymph nodes in patients with high risk testicular cancer. In: Journal of Urology. 2011 ; Vol. 186, No. 6. pp. 2245-2248.
@article{31e1e968ad4e48d6aea4566c5513298a,
title = "Predictors of positive retroperitoneal lymph nodes in patients with high risk testicular cancer",
abstract = "Purpose: Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease. Materials and Methods: Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30{\%} embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained. Results: Of 353 patients 90 (25{\%}) had greater than 30{\%} embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50{\%}) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46{\%}) and 15 (60{\%}) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95{\%} CI 1.001.04) and lymphovascular invasion (OR 3.52, 95{\%} CI 1.438.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100{\%} embryonal carcinoma was 65.5{\%}, although the negative predictive value for 30{\%} embryonal carcinoma was 85.7{\%}. Conclusions: Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options.",
keywords = "carcinoma, embryonal, lymph node excision, testicular neoplasms",
author = "Stephen Williams and R. Kacker and D. Winston and E. Bahnson and Steele, {G. S.} and Richie, {J. P.}",
year = "2011",
month = "12",
doi = "10.1016/j.juro.2011.07.101",
language = "English (US)",
volume = "186",
pages = "2245--2248",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Predictors of positive retroperitoneal lymph nodes in patients with high risk testicular cancer

AU - Williams, Stephen

AU - Kacker, R.

AU - Winston, D.

AU - Bahnson, E.

AU - Steele, G. S.

AU - Richie, J. P.

PY - 2011/12

Y1 - 2011/12

N2 - Purpose: Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease. Materials and Methods: Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30% embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained. Results: Of 353 patients 90 (25%) had greater than 30% embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50%) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46%) and 15 (60%) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95% CI 1.001.04) and lymphovascular invasion (OR 3.52, 95% CI 1.438.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100% embryonal carcinoma was 65.5%, although the negative predictive value for 30% embryonal carcinoma was 85.7%. Conclusions: Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options.

AB - Purpose: Percent of embryonal carcinoma and lymphovascular invasion in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA nonseminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection were identified to discern any other risk factors for metastatic disease. Materials and Methods: Patients who had undergone retroperitoneal lymph node dissection at our institution from 1993 to 2009 were identified and clinical charts were reviewed. A total of 90 patients with orchiectomy specimens containing more than 30% embryonal carcinoma who underwent primary retroperitoneal lymph node dissection were identified and perioperative data were obtained. Results: Of 353 patients 90 (25%) had greater than 30% embryonal carcinoma and underwent primary retroperitoneal lymph node dissection. Of these patients 45 (50%) had lymphovascular invasion. Median followup was 1.1 years. Positive lymph nodes identified at retroperitoneal lymph node dissection were noted in 30 (46%) and 15 (60%) patients with clinical stage I vs clinical stage II disease. On multivariate analysis embryonal carcinoma (OR 1.02, 95% CI 1.001.04) and lymphovascular invasion (OR 3.52, 95% CI 1.438.67) were associated with positive lymph nodes at retroperitoneal lymph node dissection. The positive predictive value for 100% embryonal carcinoma was 65.5%, although the negative predictive value for 30% embryonal carcinoma was 85.7%. Conclusions: Embryonal carcinoma and lymphovascular invasion were significantly and independently associated with the risk of occult retroperitoneal metastatic disease. These results should be considered when counseling patients about appropriate treatment options.

KW - carcinoma

KW - embryonal

KW - lymph node excision

KW - testicular neoplasms

UR - http://www.scopus.com/inward/record.url?scp=80755129063&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80755129063&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2011.07.101

DO - 10.1016/j.juro.2011.07.101

M3 - Article

VL - 186

SP - 2245

EP - 2248

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -